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BMC International Health and Human Rights

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Open Access 01-12-2015 | Research article

Comprehensive peace agreement implementation and reduction in neonatal, infant and under-5 mortality rates in post-armed conflict states, 1989–2012

Author: Madhav Joshi

Published in: BMC International Health and Human Rights | Issue 1/2015

Abstract

Background

Previous studies suggest that countries with a higher child mortality rate are more susceptible to armed conflict onset as well as recurrence. Studies do not explain conditions under which child mortality declines among post-armed conflict states. This article argues that where armed conflict is terminated through negotiation and implementation of comprehensive peace agreements (CPAs), the child mortality rate declines. This is due to the implementation of provisions in CPAs, which addresses underlying grievances of the poor, underserved and marginalized segments of the population, as well as the successful reconstruction of the health sector. CPA implementation resolves hostilities between armed rivals and facilitates the return process for internally displaced persons and refugees. The CPA implementation may also encourage the return of aid workers and health professionals to conflict-affected zones.

Method

This study utilizes new data on CPA implementation and examines neonatal, infant and under-5 mortality rates among 73 post-armed conflict countries between 1989 and 2012. Multivariate cross-sectional time series correlation (fixed effect) methods are used to analyze the data.

Results

Within post-armed conflict states, a decline in neonatal, infant and under-5 mortality rates is associated with higher CPA implementation rates. Additionally, this study shows that higher GDP per capita, higher levels of democracy, and more primary school enrollment are also associated with lower child mortality rates. On the other hand, child mortality rates increase following a rebel victory in armed conflict.

Conclusion

Ongoing armed conflicts are responsible for massive displacements and the destruction of economic, healthcare and human infrastructure, thus hindering improvements in child survival. For better health outcomes in post-armed conflict countries, ongoing armed conflict must cease through the signing and implementation of a CPA. Short-term and long-term public health issues are discussed in concluding comments.

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In this article, “child mortality rate” refers to neonatal, infant, and under-the-age-of-five mortality rate. Neonatal mortality rate measures the number of those who die before reaching 28 days of age (out of 1000 live births); infant mortality rate measures the number of infants dying before reaching 1 year of age (out of 1000 live births); under-5 mortality rate measures the probability that a newborn baby will die before reaching age five (out of 1000 newborns).

The UCDP defines a situation as armed conflict when at least 25 battle-related deaths (including military and civilian fatalities) occur in one calendar year. Armed conflict termination is coded when fighting stops in a conflict dyad for more than a year either by signing an accord, a decisive military victory (rebel or government), or no/low conflict activities. If a country is fighting multiple conflicts and one conflict is coded terminated, a post-armed conflict year starts.

Conflict termination data is updated up to 2012.

Minimum implementation means that signatories of the accord have made some efforts toward implementation, but the current rate of progress, if continued, will not produce full implementation. Intermediate implementation means that the current efforts and rate of implementation are viable to produce full implementation in two-three years. Full implementation refers to complete or nearly complete implementation processes.

Terminated in peace agreement variable is coded when the conflict is coded terminated either through (1) peace agreement, (2) ceasefire agreement with conflict regulation, or (3) ceasefire agreement.

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Title: Comprehensive peace agreement implementation and reduction in neonatal, infant and under-5 mortality rates in post-armed conflict states, 1989–2012
Author: Madhav Joshi
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC International Health and Human Rights / Issue 1/2015
Electronic ISSN: 1472-698X
DOI: https://doi.org/10.1186/s12914-015-0066-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comprehensive peace agreement implementation and reduction in neonatal, infant and under-5 mortality rates in post-armed conflict states, 1989–2012

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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